Senate Hearing Examines Indian Health Service

RAPID CITY, S.D. — Tribal leaders and members of Congress demanded greater transparency and accountability from the federal agency responsible for providing health care to members of Native American tribes during a U.S. Senate committee hearing Friday (June 17) in western South Dakota.

The field hearing of the U.S. Senate Committee on Indian Affairs focused on legislation recently introduced in the U.S. Senate that could help fix severe shortcomings at the network of hospitals run by the federal Indian Health Service. Throughout the hearing, tribal leaders and the four legislators in attendance tied many of the issues that have affected the agency for years to what they characterized as a culture that discourages transparency and disregards accountability.
“What I’ve concluded is we can’t fix the problem here by a tweak here or a fine-tune here. This requires systemic change,” U.S. Sen. John Thune, a Republican from South Dakota, said of the deep-rooted challenges the agency faces. “You can’t fix this by changing the oil and replacing the tires. We need a whole new car.”

Tribal leaders and legislators exhorted the Indian Health Service, commonly referred to as IHS, to share copies of contracts with Congress and tribes, consult tribal members before making key decisions and agree to an independent audit of the agency’s budget.

Legislators and tribal leaders cited instances when the IHS delayed notifying the tribes of upcoming changes affecting the hospitals. The examples included the last-minute notification regarding the closing of the emergency department of the hospital on South Dakota’s Rosebud Indian Reservation and the appointment of a new director responsible for overseeing all IHS facilities on the Great Plains.

“We need to be a part of this,” said William Bear Shield, chairman of the Rosebud Sioux Tribal Health Board. “We need to get away from this type of consultation, which definitely isn’t in our favor.”

The bill, introduced by Thune and U.S. Sen. John Barrasso, a Republican from Wyoming, aims to increase transparency and accountability at the IHS, and improve recruiting and retention practices at the often-remote hospitals — issues the agency has struggled with for several years.

Specifically, the bill would expand the IHS’ authority to remove and discipline problem employees, require tribal consultation when hiring hospital leadership, and provide flexibility to create competitive pay scales and offer temporary housing assistance for medical professionals. The legislation also would ensure that the inspector general of the U.S. Department of Health and Human Services, which oversees IHS, investigates patient deaths in which the IHS may have played a role.

Mary Wakefield, acting deputy secretary of the U.S. Department of Health and Human Services, said the agency would “certainly welcome” an audit of the IHS’s budget.

Legislators on Friday did not hold back their criticism toward the agency. Barrasso described some of the agency’s services as “malpractice,” while South Dakota’s Republican U.S. Rep. Kristi Noem said the IHS provides “Third World” care.
In an interview with The Associated Press ahead of the hearing, IHS principal deputy director Mary Smith said the agency recently created a search committee for the hiring of area directors, and for the first time tribal members will be officially involved in the process.

This move is so that tribal leaders can be involved in the process of picking senior leaders at IHS from the very beginning, Smith said. The agency, which is divided into 12 regions covering the country, has openings for four area directors.

Deficiencies uncovered by federal inspectors at the hospital on the Rosebud Indian Reservation in November included the lack of immediate assistance for a patient who was having a heart attack. The IHS closed the facility’s emergency room just weeks after the inspection, and the agency has not publicly said when it plans to reopen it.

Smith has acknowledged that hospitals beyond the Great Plains also face quality-of-care challenges. She said the agency has provided “technical assistance” to those drafting the legislation.